Sierra is a breast cancer survivor who was partly motivated by her struggle to get the plastic surgeries.

Another motivation was an experience she had on a date last year , when the man she was with asked to see her driver’s license because he thought she looked older than her age, at the time, of 41, the New York Daily News reported.

“That was the straw that broke the camel’s back,” she told the News. “I was 41 years old and I decided that I have to change everything about me.”

She called Dr. Rose that following Monday and told him “I want to feel like a woman,” she said.